by Dr. Daniel Rancier MD

In recent years there seems to be much more information out there about the number of concussions in sports. Not only in sports that involve physical contact like football, soccer, and hockey, but also in non-contact sports. Although it’s helpful that there is more awareness of the symptoms an athlete exhibits when they have received a concussion, the chances are that won’t reduce the total number of concussions over time.

Or will it? Are there things we can do within particular sports, or in general that can lower the exposure to concussions in athletes? The answer to that is hopefully yes. Maybe there is something that can be done within the rules of a sport that can help. Or changing equipment and adding more protection for the athlete may be another way.

In this article, we’ll look into some of those things that are being looked at or things that could be done to reduce concussions in sports. Or if an athlete has already received a brain injury, how can we make sure they don’t get another one?

The answer to the last question should be fairly obvious; remove the concussed player from the game immediately and do not let them return to action or practice until all symptoms of the concussion are gone.

The National Football League (NFL), a sport that may be the most violent of all the main sports, introduced changes last July meant to penalize teams who don’t follow the new protocol. Teams will now be subjected to fines of hundreds of thousands of dollars and possibly the loss of draft picks if they fail to take players out of games after they have sustained a concussion.

The league has been under fire for some time from doctors and players who don’t think the league is doing enough to protect their players from head injuries. Although the NFL had a previous concussion protocol, there were no fines assessed if they violated it. Under the new rules, they can be fined up to $150,000 for the first violation and a minimum of $100,000 for any subsequent breach.

The NFL has not made any significant rule changes aimed at protecting players, but the league and the union will review injury data regularly to determine if rule changes are needed to protect further and improve player safety.

Here are some key areas that have been identified that can help to reduce sports concussions or at least prevent athlete safety after sustaining an initial concussion.

Rule Changes or Enforcement of Current Rules

Player safety needs to always be at the forefront. Rules for all sports need to be aimed at protecting the athlete, regardless of their age. In fact, the rules in many sports already provide for some of that protection. But either the rules are not enforced, or the penalty isn’t enough.

Football is a great example. Some rules prohibit players from making helmet-to-helmet hits, and hitting an opponent with the crown of the helmet. But there aren’t many games you watch where it doesn’t happen. Sure, there may be a penalty on the play, but the penalties are just not strict enough to prohibit it from happening again and again.

In hockey, most hard physical contact comes with a body check. Checking with the body has always been part of hockey, but studies have shown that younger players are much more susceptible to concussions. That’s why both USA Hockey and Canadian Hockey has banned bodychecking at the Pee-Wee level (11 and 12-year-olds). But that may not be far enough.

In his 2012 book, “Concussion and Our Kids,” Dr. Robert C. Cantu recommends that body-checking only be allowed after age 14; a ban until age 15 is supported by the Canadian Pediatric Society and other groups. A leading Canadian concussion expert, Dr. Charles Tator, goes one step further: he argues for a bodychecking ban until the age of 16.

What about soccer? Well, heading the ball is looked at by most experts as one of the leading causes of concussions, specifically in younger players. Repeated contact with the ball when heading can have a long term effect, but the real danger is head-to-head contact with another player. Experts say that removing headers from soccer would change the game from one of the riskiest sports for concussions to one of the safest.

Improved Equipment

Improvements should be looked at with the equipment worn by players of all ages. Helmets are routinely worn in football and hockey but may not be the best quality or have the most recent technology.

However, in several recent studies on football helmets, there was no definitive data to support the view that advanced football helmet technology and design provides any additional protection against concussion or intracranial hemorrhage. Which means that the development of helmets that will reduce concussions is still far away.

Football players wearing poorly-fitted helmets, especially those with under-inflated air bladder liners, are at increased risk of concussion. So making sure that football helmets fit properly, and that those with air bladder linings are properly inflated, may be two of the simplest but most effective ways to minimize the risk of concussion and catastrophic brain injury.

Tests were done on helmets used in hockey but unfortunately performed very poorly. There is clearly room for improvement in the protection provided for hockey players if they want to see a reduction in the number of concussions in their sport.

Although improvements in equipment will most likely have some positive benefits in reducing concussions, it certainly won’t eliminate them. Sports that allow contact are still the riskiest when it comes to concussions, and without significant rule changes that limit the type and amount of contact players will always be at some risk.

Education and Awareness

If there is good news, the knowledge level of concussions and their symptoms is probably the highest it’s ever been. All levels of sports now have some form of concussion protocol in place. And there is more information available to coaches, trainers, parents and players than ever before. Unfortunately, there are still not enough coaches, trainers, and parents who have actively gone out to learn more about all of the symptoms to be on the lookout for.

But it can very easy to find out all you need to know. For instance, a simple visit to the Centers for Disease Control (CDC) website can provide an incredible amount of valuable information on the subject. There is detailed information at the site which is directed to coaches, parents, sports officials and teen athletes. The information includes fact sheets, symptom charts, action plans, posters and videos which include free online training targeted at high school sports coaches.

The site also provides specific information targeted towards parents that includes information about concussions for children of all ages. Detailed information is included on helmet safety with fact sheets for helmets used in several different sports. Parents can also view a free online video to learn as much as possible. Please visit the CDC site at the following link to get started.

Education about concussions is a great tool for parents, coaches, trainers and officials so that they can quickly notice the signs and symptoms of a concussion and take the appropriate action. However, the only problem with education in reducing concussions is that symptoms of a concussion are only noticed after the concussion has taken place. It can be imperative, however, is reducing occurrences of a second head injury if the proper steps are taken to remove the player and not allow a return until all symptoms are gone.

Delaying Age Level of Contact Sports

Although we already discussed rule changes, some people feel strongly that the brain is more susceptible to trauma or concussion-like symptoms when they are young and not fully developed. For contact sports such as football, hockey, and soccer, these young athletes are considered more at risk than even players at the high school or college level.

For this reason, many experts believe that rules to reduce or eliminate the amount of contact in players under the age of 14 years, will not only be useful in reducing the number of concussions but can also help them in years to come.

In his 2012 book, Concussions and Our Kids, Dr. Robert Cantu recommends that kids delay playing tackle football until age 14.  A delay in starting such contact sports or eliminating or vastly reducing contact, argues Cantu, will decrease the risk of athletes developing chronic traumatic encephalopathy (C.T.E.), which leads over time to personality changes, memory loss, even dementia. Early signs of C.T.E. have been detected in the brains of 17- and 18-year olds, says Dr. Cantu, who showed no symptoms when they were alive. Dr. Cantu was not the first to make such a recommendation: the American Academy of Pediatrics has long recommended that children wait until middle school to play collision sports like football.

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